Several methods for removing hemorrhoids are known in the art. Surgical stapling hemorrhoidectomy was introduced in the early 1990's on the basis of the so-called Whitehead closed technique for complete rectal-mucosal prolapse combined with hemorrhoids. Transection of piles through a circular stapler was first suggested by Prof. G. Allegra of the University of Florence in 1990. In 1995, Dr. J. J. O'Connor of Suburban Hospital, Bethesda, USA, and Dr. C. V. Devien of L'Hpital St. Cloud, Paris, France, performed a hemorrhoidectomy with a linear stapler.
In 1993, Dr. A. Longo of the University of Plaermo, Italy, introduced a new technique for circular stapler hemorrhoidectomy. The Longo technique involves removing internal hemorrhoids only above the dentate line. After local anesthesia, and preferably anal dilatation to avoid injury to the sphincters, a purse-string suture is made 2-3 cm above the dentate line, at the level of the origin of the internal hemorrhoids, including all internal piles, as seen in FIG. 1. The purse-string suture includes only mucosa, submucosa and hemorrhoidal tissue. In the event of large mucosal prolapse, another purse-string suture may be made above the first one. A circular stapler is inserted in the rectum beyond the purse-string sutures and the sutures are secured to the anvil shaft of the stapler, as seen in FIG. 2. The stapler is then closed and fired, thereby cutting the hemorrhoids and performing a muco-mucosal anastomosis, as seen in FIG. 3. Titanium staples are generally expelled within 3-40 days (see "Painless Haemorrhoidectomy and Mucous Prolapsectomy (PHP)", Ethicon Endo-Surgery, a Johnson & Johnson Company).
Anoscopes for performing hemorrhoidectomies are known. For example, U.S. Pat. No. 4,834,067 to Block, the disclosure of which is incorporated herein by reference, describes an instrument for internal hemorrhoidectomy. The described instrurment has a partial cylindrical body particularly useful for obliterative suturing. Although the instrument permits suturing a single hemorrhoid, nevertheless the instrument hinders suturing a plurality of hemorrhoids located about the inner perimeter of the rectal wall.
There is thus a need for an anoscope which permits suturing a plurality of hemorrhoids located about the inner perimeter of the rectal wall.